To the Editor:

I was surprised and somewhat dismayed to read that “annual prostate cancer screening tests,” which “may include ... a prostate-specific antigen blood test,” will soon be covered by Medicare for men over age 50 (“An Ounce of Prevention,” April 1998). I hope this does not lead readers to believe that PSA is a recommended routine test. It is not. Neither the AAFP nor the American College of Physicians has recommended PSA testing as routine because 1) there are no studies to support the benefits of early detection outweighing the risks of complications from treatment, especially in males over 70 years old; 2) routine PSA testing without thorough discussion of the potential outcomes of testing is inappropriate; 3) PSA is an organ-specific test, not a disease-specific test, and as such is not a reliable screening test for prostate cancer; and 4) PSA is more effective when used to follow prostate cancer patients post-treatment to determine cure versus return/metastases.

The U.S. Preventive Services Task Force Report recommends against routine testing,¹ for the reasons cited above.

I hope that by January 2000 we will have a safe, efficacious screening test for prostate cancer. If we don't, I feel it is ethically wrong (and potentially illegal) to order this test as a routine screening test, or even to refer to it as a “screening test.”

While an ounce of prevention is worth a pound of cure, a pound of prevention is not necessarily better.